Individual provider Active NPI

Charles Cam Luu, O. D.

  • Optometrist
  • Fullerton, CA
National Provider Identifier
1306831649
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8628T Issued in CA
Practice address
1400 N Harbor Blvd Ste 101
Fullerton, CA 92835-4107
Phone
(714) 888-2080
Fax
(714) 888-2090
NPI assigned
Sep 13, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8628T CA Primary

Addresses

Primary practice location

1400 N Harbor Blvd Ste 101
Fullerton, CA 92835-4107

Mailing address

18382 Nicklaus Rd
Yorba Linda, CA 92886-7051
Phone (714) 425-5041

Other practice location 1

9351 Bolsa Ave
Westminster, CA 92683-5928
Phone (714) 494-1333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091222000149 CA Practitioner - Optometry 5799825881 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1984
Medicare assignment
May accept Medicare assignment
Group practices
Jeffrey V. Winston, M.D., a Professional Corp.Group PAC ID 4880658558, 7 clinicians

Practice addresses (Care Compare)

1400 N Harbor Blvd
Suite 101
Fullerton, CA 92835-4107
Phone (714) 888-2080

Merit-based Incentive Payment System (MIPS)

Final score
74.81 of 100Reported as group
Quality
95.75
Improvement activities
40
Cost
10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8628TCAMDOptometrist
6931CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey V. Winston, MD a Professional Corp Optometrist CurrentSince Apr 24, 2012 Accepting new patients
Melody Tam Nguyen OD Inc Optometrist PastSince Oct 1, 2013 Accepting new patients

Locations

1400 N Harbor Blvd
Ste 101
Fullerton, CA 92835
Phone (714) 888-2080

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1306831649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18382 NICKLAUS RD",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928867051",
            "telephone_number": "714-425-5041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N HARBOR BLVD STE 101",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354107",
            "telephone_number": "714-888-2080",
            "fax_number": "714-888-2090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9351 Bolsa Ave",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "CA",
            "postal_code": "926835928",
            "country_code": "US",
            "telephone_number": "714-494-1333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUU",
        "first_name": "CHARLES",
        "middle_name": "CAM",
        "name_prefix": "Dr.",
        "credential": "O. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8628T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.